Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: The association between geographic factors, including transport distance, and pediatricemergency medical services (EMS) run clustering on out-of-hospital pediatric endotracheal intubation isunclear. The objective of this study was to determine if endotracheal intubation procedures are more likely tooccur at greater distances from the hospital and near clusters of pediatric calls.

Methods: This was a retrospective observational study including all EMS runs for patients less than 18years of age from 2008 to 2014 in a geographically large and diverse Oregon county that includes denselypopulated urban areas near Portland and remote rural areas. We geocoded scene addresses using theautomated address locator created in the cloud-based mapping platform ArcGIS, supplemented with manualaddress geocoding for remaining cases. We then use the Getis-Ord Gi spatial statistic feature in ArcGIS tomap statistically significant spatial clusters (hot spots) of pediatric EMS runs throughout the county. We thensuperimposed all intubation procedures performed during the study period on maps of pediatric EMS-runhot spots, pediatric population density, fire stations, and hospitals. We also performed multivariable logisticregression to determine if distance traveled to the hospital was associated with intubation after controlling forseveral confounding variables.

Results: We identified a total of 7,797 pediatric EMS runs during the study period and 38 endotrachealintubations. In univariate analysis we found that patients who were intubated were similar to those who werenot in gender and whether or not they were transported to a children’s hospital. Intubated patients tendedto be transported shorter distances and were older than non-intubated patients. Increased distance fromthe hospital was associated with reduced odds of intubation after controlling for age, sex, scene location,and trauma system entry status in a multivariate logistic regression. The locations of intubations weresuperimposed on hot spots of all pediatric EMS runs. This map demonstrates that most of the intubationsoccurred within areas where pediatric EMS calls were highly clustered. By mapping the intubationprocedures and pediatric population density, we found that intubation procedures were not clustered in asimilar distribution to the pediatric population in the county.

Conclusion: In this geographically diverse county the location of intubation procedures was similar to theclustering of pediatric EMS calls, and increased distance from the hospital was associated with reducedodds of intubation after controlling for several potential confounding variables. [West J Emerg Med.2016;17(5)656-661.]